141 NE 102 St (5)Date
Legal Description.S;EL/ v 0-0 4 ( .N< /3 Historically Designated: Yes No ✓
Owner/Lessee / Tenant (- t E-2 1 LL
Owner's Address 1 L1 1 N E (0 2 SI" WET
Contractin Co. 6 Log SE :Ca-Irk/ ivC
Qualifier 6%/Z-e6 ORI e0QR1
Signa e of owner and/or C
Notary as to Owner and/or . . •, Pres nt
My Commission Expires:
1
FEES: PERMIT- ^ e RADON
APPROVED:
Zoning
Mechanical
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address t t- & 102 S7 Tax Folio it - ,3.7_)06 - 0/3 - 7B3
ndcfkaliciDAMPBELINERRILL III
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC370615
MY COMMISSION EXP,_ $ 24 1998
00
Address
Building Electrica
Master Permit # 4
Phone 3 - K g 1 -0-110
1 Su- 10o ST
SS# Phone 3'S 2-0 - 70E
State # Fs5Cwt5 bg •3 Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION So2.C�L - cYSTE
l — et l4s .2 b -- DFt/r CAS
Square Ft. Estimated Cost (value) 2 y 00
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Signat e o t- 6,';,.
JAMES C •1 • • :ELL MERRIL
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC370615
•, •. 41998
Notary s to Cron ac or or Owner- :udder
My Commission Expires: ilk
C.C.F. /, SO NOTARY
Date
TOTAL DUE y-/. PTO
Plumbing Engineering